German Society of Oto-Rhino-Laryngology, Head and Neck Surgery.
82nd Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery.
Freiburg,
01.-05.06.2011.
DÃ¼sseldorf: German Medical Science GMS Publishing House; 2011. Doc11hno55

Outline

Background: Hereditary haemorrhagic teleangiectasia (HHT, Morbus Osler-Rendu-Weber) is most notably characterized by vulnerable and bleeding vascular formations of the skin and superficial mucosal tissue. Epistaxis is one of the most common symptoms of the afflicted patients, with an incidence of more than 90%. A variable series of treatments have been described, ranging from smooth nasal ointments to the complete surgical acclusion of the nose. The objective of our work is the presentation of first experiences in treating patient suffering from hereditary haemorrhagic teleangiectasia and chronically recurrent epistaxis with a custom-built nasal olive made from silicone.

Material and Methods: Four patients (3 female, 1 male) aging from 40 to 65 with known HHT have been treated in the ENT-Department of the University Hospital of Homburg/ Saar from 11/2008 to 11/ 2010 with ND-YAG-laser and a nasal olive. After laser-treatment an imprint of the nasal aditus was taken to be able to manufacture a custom-built silicone nasal olive. Patients were wearing the nasal olive for eight to ten hours a day. Check-ups were made every six weeks. The observation period was six to 24 months.

Results: The utilisation of a silicone nasal olive led to a distinct reduction of recurrent epistaxis. Apart from the nasal olive, our patients needed no further treatment of the nose during the observation period except for a smooth nasal ointment. Insertion and removal of the nasal olive was handled by the patients themselves. Wearing the nasal olive as a sign of acceptance underlines the feeling of relief. The local manipulation in handling the nasal olive caused no epistaxis in itself. All patients agreed to an improvement of life quality. The number of medical consultations decreased significantly due to the nasal olive.

Conclusion: Utilisation of an individually manufactured silicone nasal olive is a promising extension to the established treatments of epistaxis in HHT patients. Tolerance towards this treatment by the patients was high due to the low personal burden and encumbrance. The extended use of the presented method with HHT-patients is desirable and a more prolonged observation period is necessary in the future to judge the long-term efficiency of the silicone nasal olive.